Why Most Doctors Leave Money on the Table: A Guide to Contract Negotiation

You’ve spent years in training, survived overnight calls, and are finally ready to sign that first—or next—job offer. But here’s the uncomfortable truth: most physicians leave money, flexibility, and long-term security on the table by not negotiating their contracts. In fact, many don’t even know they can negotiate.

The High Stakes of the Fine Print

Michael Johnson, a physician-focused attorney, puts it bluntly: “Most of us walk straight into our first job without understanding what we’re signing. We don’t even know if we can negotiate, let alone what’s fair or normal”.

Contracts are more than salaries and bonuses—they’re blueprints for your work-life balance, legal protections, and long-term growth. Overlooking a non-compete clause, underestimating arbitration terms, or failing to review intellectual property rights can cost you down the line.

Common Red Flags in Physician Contracts

Dr. Glenn Loomis emphasizes that contracts are designed for when things go wrong: “They’re meant to be negotiated and then put in a drawer... They only come out if there’s a dispute”. That’s why hidden clauses matter most. Key elements to review include:

• Termination terms
• Restrictive covenants (non-competes)
• IP and confidentiality clauses
• Compensation structures and bonus criteria

If anything gives you a “hinky feeling,” as Loomis puts it, don’t ignore it. That’s often your best signal.

Why Doctors Don’t Push Back—And Why They Should

The culture of medicine teaches us to advocate fiercely for patients, but rarely for ourselves. Michael Johnson notes that if senior physicians don’t challenge bad contracts, “it reduces leverage downstream” for newer grads.

Redefining this culture means normalizing negotiation—not as conflict, but as professionalism.

Tips for Smarter Negotiation

• Start with Data: Use resources like Offcall, MGMA benchmarks, and peer networks to understand what’s standard for your specialty and region.
• Talk to a Lawyer: A contract review with a physician-attuned attorney is a smart investment.
• Evaluate More Than Salary: Look at work hours, call burden, tail coverage, CME funds, and how compensation is calculated.
• Ask Questions: “Interview them as much as they’re interviewing you,” says Loomis. Culture, leadership style, and practice dynamics matter.
• Be Willing to Walk: Your best leverage is your ability to say no. If terms don’t meet your needs or values, explore other options.

Negotiation isn’t about greed—it’s about clarity, sustainability, and self-respect. Whether you’re on your first offer or fifth, taking time to understand and shape your contract is one of the most powerful decisions you’ll make in your career.